Healthcare Provider Details

I. General information

NPI: 1245079391
Provider Name (Legal Business Name): ELIZABETH WINGARD MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2024
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2004 HOGBACK RD STE 16
ANN ARBOR MI
48105-9738
US

IV. Provider business mailing address

2004 HOGBACK RD STE 16
ANN ARBOR MI
48105-9738
US

V. Phone/Fax

Practice location:
  • Phone: 734-585-0495
  • Fax:
Mailing address:
  • Phone: 734-585-0495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number68011007678
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: